2010 Northern Maine Soap Box Derby Application Form
Please Print Clearly. Have a parent or guardian sign #3. Submit with your non-refundable registration fee. Applications must be received by May 1, 2010. Registration Fee: Before April 15th ~ $25 per racer…After that date $30 per racer.
1. Complete the following: (Please Print)
Name:_________________________________________Age:_______ Mailing Address:________________________________________________ School:_______________________Grade:______ S.S.#:_______
Date of Birth:____/____/____Height:________________Weight:_________
Parents Names:______________________________________
Telephone:_______________ Cell Phone: ____________
E-mail Address__________________________________
T-shirt Size: Check One ( )Youth Med ( )Youth Lg.
( )Adult Sm ( ) Adult Med ( ) Adult Lg. ( ) Adult XLg.
2. Attach a check (Payable to Northern Maine Soap Box Derby) non-refundable registration fee. Mail to the address below:
NMSBD Registration
P.O. Box 84
Houlton, ME 04730
3. Parent/Guardian Signature: I,________________________, give
permission for my son/daughter/ward to participate in the 2010 Northern
Maine Soap Box Derby Race, subject to all rules & regulations of the All
American Soap Box Derby.
4. I will be racing in (check one):______Stock _____Super Stock
5. Cars will be assigned new numbers this year.
6. Please list sponsors of your Car: ___________________________
____________________________________________________
(More room on back if needed)
7. Attach a photocopy of your birth certificate (from the town, not the hospital) & a Photo to be used in the NMSBD Pioneer Times Story. Please return all necessary papers & registration fees to the above address and if you have any questions about registration please call Marie Carmichael at 532-1310 or e-mail her at rec.programs@houlton-maine.com
